Trump Administration Gags Doctors from Speaking about Abortion to Low-Income Women

Published Mar 11, 2019

HHS issued a rule that significantly alters the Title X program, the federal grant program that supports family planning services for low-income individuals.

What happened: The Department of Health and Human Services (HHS) issued a final rule that significantly alters the Title X program, the federal grant program that supports family planning services for low-income individuals. The changes would restrict participating doctors from providing scientifically-backed information to patients on all their medical options.

Why it matters: Critics describe the rule as a “gag rule” that undermines the doctor-patient relationship. It forces medical personnel to withhold pertinent information from low-income patients, information critical to a patient’s decision-making process. Patients expect their doctors to be honest with them and provide comprehensive medical information based on the best available science. Policies that touch on science-based issues, including family planning policy, should be driven by scientific evidence, not by political ideology.

The Department of Health and Human Services issued a final rule that restricts medical doctors from providing their patients with scientific information about family planning. The rule may also channel women away from health providers that offer family planning measures that are rooted in science. These women are expected to seek family planning counseling from faith-based organizations, many of which only guidance on abstinence measures. The science is clear on abstinence-only education – it is not an effective family planning tool. Abstinence education has been shown in the scientific literature to be one of the least effective methods to prevent unwanted pregnancies.

Specifically, the HHS rule eliminates the requirement that Title X clinics provide pregnancy counseling that includes the discussion of abortion as an option, if requested by the patient. Under the new HHS rule, the extent to which counseling for abortion is permissible is unclear. The rule allows a very limited exception to this restriction: if a pregnant woman has already decided to have an abortion and explicitly asks for a referral, then a doctor (and no other clinical staff) would be permitted (though not required) to provide a list of health care providers that offer comprehensive prenatal care, some of which also provide abortion (but the doctor cannot specify which health care providers on the list offer abortion services).

The medical community overwhelming disagrees with the policy. The American Medical Association (AMA) issued a statement saying that the rule “would undermine patients’ access to high-quality medical care and information, dangerously interfere with the patient-physician relationship and conflict with physicians’ ethical obligations.” Additionally, AMA states that a lack of clarity about whether counseling for abortion is allowed could have a chilling effect on physicians and other providers when counseling patients on their options.” A joint letter co-signed by 19 prominent health organizations state that “by forcing providers to omit critical information about health care and resources available, the final regulation directly undermines patients’ confidence in their care.”

The HHS rule may even be a violation of scientific ethics. Some medical groups argue that if doctors and other medical personnel cannot provide patients with comprehensive information on all available medical procedures then this violates the principles of informed consent. For instance, the AMA’s Code of Medical Ethics states that clinicians should “present relevant information accurately and sensitively, in keeping with the patient’s preferences” and asserts that “withholding information without the patient’s knowledge or consent is ethically unacceptable.” Several professional medical organizations – including the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, and the American Academy of Physician Assistants – are even more explicit, describing the providing of comprehensive, unbiased information of a woman’s pregnancy options as essential for informed consent and fundamental to a patient’s right to self-determination.

While the Trump administration is not the first administration to modify Title X such that doctors must hide medical science from their patients, it is the first administration since the Reagan administration to enact gag rules both internationally and domestically. Most of the anti-science changes in this rule were also enacted during the Reagan administration, but because of court challenges and the reinterpretation of regulation under the George HW Bush era, the rules were in effect for only a few weeks and were formally reversed during the Clinton administration. However, unlike the Reagan-era rule, the current Trump administration’s rule may be in a violation of the 2010 Affordable Care Act, which explicitly forbids regulations that create “unreasonable barriers to the ability of individuals to obtain appropriate medical care.”

The Trump administration’s finalized rule will almost certainly have major repercussions on low-income women across the country. Under the regulations, providers such as Planned Parenthood, will have to choose between forcing their staff to violate medical ethics and declining to offer services under Title X. Planned Parenthood is a particular important health provider of Title X services across the US; in 13 states, Planned Parenthood clinics were the site of care for 40% of women who obtained publicly funded contraceptives. This rule would almost inevitably shrink the network of available health providers that offer family planning services for low-income women especially in rural areas, further exasperating the struggles experienced by this disenfranchised group.